Primary bone tumors of the pelvis presenting as spinal disease

Low back pain and sciatica are usually attributed to localized structural pathology; however, tumors of the pelvis may also cause these symptoms. Pelvic bone neoplasms are seldom immediately diagnosed and, therefore, may result in significant morbidity and mortality. Fourteen cases of malignant primary bone tumors of the pelvis that caused spinal symptoms were referred to our Musculoskeletal Tumor Service. Several recurring characteristics of these cases that may alert the clinician to the possibility of underlying pelvic bone malignancy in a patient with low back pain were identified: 1) age ≤45 years; 2) insidious onset of symptoms without antecedent trauma; 3) prolonged symptoms for more than 1 month; 4) progressive pain that fails conservative therapy; and 5) presence of anorexia, malaise, or night pain. We suggest that in diagnosis of a patient presenting with these characteristics, the clinician instruct that the pelvis be included in initial radiographs. If plain radiograph is non-diagnostic and symptoms remain unresponsive, we recommend obtaining a bone scan, and then, if necessary, computerized tomography or magnetic resonance imaging.